About the Role:

Bracane Company is seeking a dedicated and detail-oriented Utilization Review RN to join our team in Austin, TX. This is an exciting opportunity for a clinical professional to make a meaningful impact by ensuring patients receive the right care at the right time. If you're passionate about healthcare quality and patient advocacy, we want to hear from you!

Responsibilities:

Conduct utilization review assessments to evaluate medical necessity and appropriateness of care

Perform concurrent, prospective, and retrospective reviews of patient cases

Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans

Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review decisions

Document and communicate review findings accurately and in a timely manner

Identify opportunities for care improvement and ensure compliance with payer guidelines

Support denial management and appeals processes as needed

Requirements:

Active and unrestricted RN license in the state of Texas

Minimum 2-3 years of clinical nursing experience required

Prior utilization review, case management, or managed care experience strongly preferred

Familiarity with InterQual or Milliman clinical criteria

Strong knowledge of medical terminology, coding, and payer guidelines

Excellent analytical, communication, and critical thinking skills

Ability to work independently and manage a high-volume caseload efficiently

About Us:

Bracane Company is a trusted name in healthcare staffing and management solutions, committed to connecting top clinical talent with organizations that need them most. Our clients rely on us for our expertise, integrity, and dedication to quality care outcomes. At Bracane Company, employees thrive in a supportive environment that values their skills and invests in their professional growth.